Laserfiche WebLink
Date P�,����.,vo.�.Pa,m,�. ��33�_/ <br /> ApplicatioT Fot 6�0o Deo� • _ <br /> PUBLIC WOR�CS PERMIT P��bT�wmPSFce s — <br /> i': <br /> �-� less FpU� F?n Pa:.� .S <br /> Print or Type Onty � n � er�.,^�..❑,�„ S 7�� — <br /> rv o 0 <br /> ,s ri ri <br /> r= <br /> .a +p <br /> �P �Jls��l � 7u,;� v2r� ✓P��t��Pr; ���� (��l �y7-�/6v <br /> Ownei Aqa:�i�4 4'.:oe6E �J � Cu1' 7iP � Phnno <br /> p O Sl W <br /> O 1- S <br /> � �.c �J / 7�� U11t�a-✓_>�f�F�t2r_�'7���2c��.3y��.p <br /> AppliCant M;��br�G AAAmss C�h� Z�0 Phone � <br /> DescribeProposrAWork �C/1�✓r✓ GY ,�}`���K /�//�NL /�VCC. /9 JX/n�V4�/t/ o7ff� �j <br /> /,! LP.���{f -_ - -- ---�-�--r------ <br /> -- - - -- - -------- W <br /> Project Adaress Id known! ��Vy�_ U�.� V-��__���L._ _________ ___ � <br /> Attaeh four(4)eopios of plans fo� proP��sed wo�k Diav: !n .r,ib� .ic.i oote thr'oilcwmq as apt>hrab�e <br /> � <br /> • Property LineS • G��nir,rlmn nt stre��t � <br /> • Out'ine and dimensions ol all ex�shng anA • Inrlicate North <br /> proposed S�ruG�ures on Ihe lol • �now any nrcpoS�A gradmr� r,hanu�•s <br /> • ExiSting and proposed utilitie5 • Show mrasurements � <br /> DO NOT WRITE 6ELOW THiS LINE O <br /> PERMIT CONDITIONS <br /> 1.All callx tor inapedion shall be made 24 hrs.in advance-phone 259•661 O. � <br /> 2.Ail wo�lc shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificalions. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBEp 1•800•424•S55S. <br /> � � j1 s fx^� f/9rt�i n� l7�'y-��¢or- �1'e�7�i`� �7-y�. and Z <br /> f'�ihl,z !�/o,�k� lhs�cc�rr �;'�'ect�`�. .�, -�'o,N, 0 <br /> .S. M�M�M c�cGe41 � -FA-� Nyd►�+it � w�t� �-/���c boK � <br /> � <br /> 0 <br /> a <br /> � ACKNOWLECG[MENT OF CONDITIONS <br /> � 1 h„„nAer��an�d ownnVapphcant hereby agrees to hold and save harm- <br /> �-- - --- ---� ��ess Ihe Gdy o� Fvere�t Irom any and ali claims for Aamages. costs. <br /> /- ; e�pense; or causes oi acUo� that may anse Uewuse ol installation <br /> �,. � C� g/7? �Cl/1 and mamtenanr,e n! Ihn improvement or other nqhbof�way use heieto <br /> ��'�� 1 <br />